conleyclan
Guru
I am thinking this should be coded as 33697 and 33641, but I want to be sure it is correct. Any input would be greatly appreciated. Thank you!!
Cardiothoracic Surgery Operative Report
PREOPERATIVE DIAGNOSES: Tetralogy of Fallot with absent pulmonary valve
syndrome, dilated pulmonary arteries, respiratory distress.
POSTOPERATIVE DIAGNOSES: Tetralogy of Fallot with absent pulmonary valve
syndrome, dilated pulmonary arteries, respiratory distress.
PROCEDURES PERFORMED:
1. Repair of tetralogy of Fallot with absent pulmonary valve syndrome.
2. Bilateral reduction pulmonary artery plasty.
3. Placement of monocusp Gore-Tex pulmonary valve.
4. Placement of transthoracic single-lumen Broviac catheter.
INDICATIONS FOR PROCEDURE: ----- comes to the OR for repair of
tetralogy of Fallot with absent pulmonary valve syndrome. The patient
required intubation and ventilatory support because of a respiratory arrest
secondary to his syndrome. I discussed the surgery and associated risk
with the family.
OPERATIVE FINDINGS: The patient had dilated branch pulmonary arteries.
There was no pulmonary valve tissue present. There was moderate-sized
ventricular septal defect. There was a large atrial septal defect.
OPERATIVE TECHNIQUE: With the patient in supine position, under excellent
general anesthesia, the chest and abdomen were prepped and draped in the
standard fashion. The chest was entered through a standard median
sternotomy incision. The chest retractor was then placed and opened. The
thymus was excised. The pericardium was divided to the right of the
midline, suspended laterally. A segment of pericardium was harvested and
placed in glutaraldehyde. The patient was noted to have dilated branch
pulmonary arteries. Pursestring sutures were placed in the distal
ascending aorta, SVC, and IVC. Intravenous heparin was given. The heart
was then cannulated in the standard fashion. The cardiopulmonary bypass
was instituted and the patient was cooled down to 28 degrees Centigrade.
Tourniquets were placed around both caval cannulas. An LV vent was placed
through the right superior pulmonary vein. An antegrade cardioplegia
catheter was placed in the proximal ascending aorta. The aorta was then
cross-clamped and the heart arrested using cold antegrade blood
cardioplegia. A cardioplegia was delivered approximately every 20 minutes
during the cross-clamp. I then proceeded to extensively mobilize both
branch pulmonary arteries. The pulmonary trunk approximately was
transected. The aorta was then transected and the Lecompte maneuver was
performed. The aorta was then reanastomosed using the 5-0 Prolene in a
running fashion. I then proceeded to plicate the anterior aspect of both
branch pulmonary arteries. A 7-mm Hegar dilator was placed into the branch
pulmonary arteries to help size the plication. The plication was performed
using the 5-0 Prolene in a 2-layer fashion. A segment of the proximal main
pulmonary artery was resected. The anterior aspect of the smallish main
pulmonary artery was then opened longitudinally. A ventriculotomy was then
performed starting at the level of the right ventricular outflow where the
pulmonary valve annulus was present. The ventriculotomy was performed and
through the ventriculotomy, I visualize VSD. The VSD look was moderate in
size and appeared to be slightly restricted. The VSD was closed using the
patch of Savege material. The patch was sewn in place using the 5-0
Prolene in a running fashion. The posterior aspect of the main pulmonary
artery was then sutured to the posterior aspect of the right ventricular
outflow tract. A monocusp Gore-Tex pulmonary valve was then constructed
and sewn to the ventriculotomy using 6-0 Prolene in a running fashion. A
transannular patch of autologous pericardium was then used to reconstruct
anterior aspect of the right ventricular outflow tract using 5-0 Prolene in
a running fashion. I then proceeded to open the right atrium through which
I was able to identify a large atrial septal defect. The ASD was closed
using the patch of autologous pericardium. I left a small opening
superiorly to allow for some right-to-left shunting postoperatively. The
atriotomy was then closed using the 5-0 Prolene in a 2-layer fashion. The
patient was placed in the Trendelenburg position. The antegrade
cardioplegia catheter was then used as an aortic root vent. The aortic
cross-clamp was then removed. The heart resumed a normal sinus rhythm.
Temporary atrial and ventricular pacing wires were placed. A transthoracic
right atrial Broviac catheter was placed. Once fully warmed, the LV vent
was removed and the patient was weaned from cardiopulmonary bypass without
any difficulty. Modified ultrafiltration was performed. The heart was
then decannulated. The pursestring sutures were tied and the cannulation
sites were enforced using 5-0 Prolene suture. Careful hemostasis was
obtained. The RV pressure was measured post bypass and it was just below
half-systemic. Because of mediastinal swelling, the chest was left open.
The incision was then closed using the patch of Silastic material.
Mediastinal chest tube was placed. Sterile dressing was applied. The
patient tolerated the procedure well. I was present during the whole
procedure.
Cardiothoracic Surgery Operative Report
PREOPERATIVE DIAGNOSES: Tetralogy of Fallot with absent pulmonary valve
syndrome, dilated pulmonary arteries, respiratory distress.
POSTOPERATIVE DIAGNOSES: Tetralogy of Fallot with absent pulmonary valve
syndrome, dilated pulmonary arteries, respiratory distress.
PROCEDURES PERFORMED:
1. Repair of tetralogy of Fallot with absent pulmonary valve syndrome.
2. Bilateral reduction pulmonary artery plasty.
3. Placement of monocusp Gore-Tex pulmonary valve.
4. Placement of transthoracic single-lumen Broviac catheter.
INDICATIONS FOR PROCEDURE: ----- comes to the OR for repair of
tetralogy of Fallot with absent pulmonary valve syndrome. The patient
required intubation and ventilatory support because of a respiratory arrest
secondary to his syndrome. I discussed the surgery and associated risk
with the family.
OPERATIVE FINDINGS: The patient had dilated branch pulmonary arteries.
There was no pulmonary valve tissue present. There was moderate-sized
ventricular septal defect. There was a large atrial septal defect.
OPERATIVE TECHNIQUE: With the patient in supine position, under excellent
general anesthesia, the chest and abdomen were prepped and draped in the
standard fashion. The chest was entered through a standard median
sternotomy incision. The chest retractor was then placed and opened. The
thymus was excised. The pericardium was divided to the right of the
midline, suspended laterally. A segment of pericardium was harvested and
placed in glutaraldehyde. The patient was noted to have dilated branch
pulmonary arteries. Pursestring sutures were placed in the distal
ascending aorta, SVC, and IVC. Intravenous heparin was given. The heart
was then cannulated in the standard fashion. The cardiopulmonary bypass
was instituted and the patient was cooled down to 28 degrees Centigrade.
Tourniquets were placed around both caval cannulas. An LV vent was placed
through the right superior pulmonary vein. An antegrade cardioplegia
catheter was placed in the proximal ascending aorta. The aorta was then
cross-clamped and the heart arrested using cold antegrade blood
cardioplegia. A cardioplegia was delivered approximately every 20 minutes
during the cross-clamp. I then proceeded to extensively mobilize both
branch pulmonary arteries. The pulmonary trunk approximately was
transected. The aorta was then transected and the Lecompte maneuver was
performed. The aorta was then reanastomosed using the 5-0 Prolene in a
running fashion. I then proceeded to plicate the anterior aspect of both
branch pulmonary arteries. A 7-mm Hegar dilator was placed into the branch
pulmonary arteries to help size the plication. The plication was performed
using the 5-0 Prolene in a 2-layer fashion. A segment of the proximal main
pulmonary artery was resected. The anterior aspect of the smallish main
pulmonary artery was then opened longitudinally. A ventriculotomy was then
performed starting at the level of the right ventricular outflow where the
pulmonary valve annulus was present. The ventriculotomy was performed and
through the ventriculotomy, I visualize VSD. The VSD look was moderate in
size and appeared to be slightly restricted. The VSD was closed using the
patch of Savege material. The patch was sewn in place using the 5-0
Prolene in a running fashion. The posterior aspect of the main pulmonary
artery was then sutured to the posterior aspect of the right ventricular
outflow tract. A monocusp Gore-Tex pulmonary valve was then constructed
and sewn to the ventriculotomy using 6-0 Prolene in a running fashion. A
transannular patch of autologous pericardium was then used to reconstruct
anterior aspect of the right ventricular outflow tract using 5-0 Prolene in
a running fashion. I then proceeded to open the right atrium through which
I was able to identify a large atrial septal defect. The ASD was closed
using the patch of autologous pericardium. I left a small opening
superiorly to allow for some right-to-left shunting postoperatively. The
atriotomy was then closed using the 5-0 Prolene in a 2-layer fashion. The
patient was placed in the Trendelenburg position. The antegrade
cardioplegia catheter was then used as an aortic root vent. The aortic
cross-clamp was then removed. The heart resumed a normal sinus rhythm.
Temporary atrial and ventricular pacing wires were placed. A transthoracic
right atrial Broviac catheter was placed. Once fully warmed, the LV vent
was removed and the patient was weaned from cardiopulmonary bypass without
any difficulty. Modified ultrafiltration was performed. The heart was
then decannulated. The pursestring sutures were tied and the cannulation
sites were enforced using 5-0 Prolene suture. Careful hemostasis was
obtained. The RV pressure was measured post bypass and it was just below
half-systemic. Because of mediastinal swelling, the chest was left open.
The incision was then closed using the patch of Silastic material.
Mediastinal chest tube was placed. Sterile dressing was applied. The
patient tolerated the procedure well. I was present during the whole
procedure.